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General NPI Number Information
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NPI Number | 1881953628
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Entity Type | Individual
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Provider Name | PRATHAP JAYARAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 11 ORTHO LN
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City | ATLANTA
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State | GA
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Zip | 30329
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Country | US
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Telephone | 410-225-8790
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ORTHO LN
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City | ATLANTA
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State | GA
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Zip | 30329-2038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 45938
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 90850
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 90850
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License Number State | GA
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